The November 9-11 Sustainability Pause and Reflect Regional Workshop in Dakar, Senegal gathered government and supporting partner representatives from the 11 Act | West-supported countries and stakeholders from The END Fund, RTI, SCI Foundation, COR-NTD, WHO, USAID, to Johnson & Johnson—all to discuss challenges, opportunities, and priorities for mainstreaming NTDs services into national health systems and promoting country ownership. Integrating NTD services into national health systems would ensure that NTD treatments are covered by national health insurance and more accessible to people afflicted by NTDs.

Several points stood out among the event’s key takeaways and themes, most notably:

• Mass drug administrations (MDAs) in schools are critical for sustainability. Togo is moving forward with a deworming pilot program to better reach and treat school-aged children. As the country has very high school attendance rates, this program could have a big impact. In a similar move, an attendee from Côte d’Ivoire highlighted their push to decouple school sensitization programs from drug administration campaigns. The goal of this move is to build awareness through more permanent and ongoing sensitization programs. These efforts show the value of increased collaboration between the NTD and education sectors for sustainability and country ownership.

• Countries emphasized the need to mainstream NTDs morbidity services. This could be done by adding morbidity services into either universal health care packages or the national health insurance benefits package where applicable. Representatives from Ghana, Côte d’Ivoire, and Senegal shared their methods on how to integrate NTD care into national health insurance packages and/or gratuity mechanisms. These three countries have already instituted a more formal collaboration between their NTD programs and the health insurance sector, with Ghana serving as a pioneer. Still, problems remain, such as ensuring that health centers are reimbursed by insurance providers and that covered packages are fully implemented.

• Socio-economic factors like insecurity and population displacement affect NTDP sustainability activities. Ministry of Health staff from Niger, Togo and Mali noted these factors as concerns for their programs. Each NTD program adopted a different strategy according to their context. For example, while Mali might need to interact with insurgents in the North to perform certain field activities, insecurity is less widespread in Togo. In other words, these issues are disruptive in some countries, while less so in others.

• As countries advance through the sustainability stages, Act | West technical assistance needs to adapt to the new context. This technical assistance needs to adjust as countries increasingly use national systems to incorporate, fund, and sustain their own NTD programs in place of traditional donors.

• Continued funding for NTD elimination and control is still an issue for many countries. Even so, participants recognized that while funding and donors are necessary, money alone is insufficient to sustain a program or make it sustainable. For NTD programs to be successful, Ministries of Health and other national stakeholders need to increase country ownership, engage government agencies, leverage existing platforms to foster integration, mobilize resources, facilitate cross-sector links, and leverage data.

• Local leadership and engagement are crucial for country ownership. Country representatives spoke on the need for their NTD programs to find new ways to engage local leaders and communities to ensure that NTD services, including prevention and behavior change, are prioritized and integrated into decentralized systems and local development plans.

Though individual country challenges make each sustainability journey unique, a common refrain was the importance of cross-sectoral collaboration as the path forward for NTD program integration and country ownership. Opportunities like the Pause and Reflect conference offer Ministries of Health a chance to learn from peer NTD programs and put successful methods against shared NTD problems into practice.